25 September 2024

The Hon. R.A. SIMMS (21:22): I rise to indicate that the Greens will be supporting the bill. The Hon. Mr Pangallo and I have disagreed on a few issues over the last few days but we do agree on this issue. I certainly support his efforts to tackle cigarette use, particularly among young people. I think this is a bold step in terms of taking a phased approach to stopping the sale of tobacco products to young people, initially, but of course what this bill does is phase out cigarette use among a whole new generation coming through. I think that is a worthy public policy initiative.

The bill prohibits the sale of tobacco products to anyone born after 1 January 2009, or people who are currently 15 years or younger. I do note that there is an amendment filed by the Hon. Frank Pangallo that changes that date to the year 2007, which would impact anyone who is 17 years or younger. I am happy to entertain that amendment should it be required to secure the passage of the bill through this place.

The Greens have always supported a health approach to substance use. We believe that harm minimisation is the most appropriate way to reduce the adverse health, social and economic consequences of alcohol and other drug use. We want a reduction in high-risk uses of nicotine and tobacco, as we acknowledge that they are substances that cause serious harm.

It is important for us to note that there are supports put in place to help young people under the age of 15 move away from nicotine; however, we note that this is a private member's bill, and those services would need to be provided by the government. I look forward to hearing from the government down the track around what they might do in that regard should this bill become law.

This is an argument that the Greens have made at a federal level. During the time when vaping reforms were passed by the federal parliament in June, the Greens argued that the increase in nicotine dependence is a significant public health problem. We want to keep tobacco and nicotine products out of the hands of kids, but we also want to ensure that people can access support to address their addiction when they need it.

We are pleased that this bill does not take a punitive approach to the possession of tobacco products but instead prohibits the sale of such products to young people. New Zealand was the first jurisdiction to ban smoking for future generations. It was accompanied by other measures to make smoking less affordable and accessible and included dramatically reducing the legal amount of nicotine in tobacco products. At the same time, they increased funding for health services and rolled out additional quitting services.

This was a comprehensive package of reforms and supports that was due to see health benefits at a significant level for people in New Zealand. Unfortunately, the new right-wing government in New Zealand has scrapped these reforms before they were due to be implemented in July this year. I think that is very disappointing. I also notice that the Tory government announced a plan to move down this path but never achieved that. I do hope, though, that governments in other jurisdictions take action on this.

The Greens will therefore be supporting the bill by the Hon. Frank Pangallo as we consider it to be consistent with promoting better health outcomes for people born after the year 2009, but I do want to use this opportunity to call on the government to provide additional services to support people using tobacco products.

In considering this bill, I would urge elected members to consider whether, if we had our time again, we would choose to make tobacco a product available to young people and adults here in our state. The reality is there are significant health risks that flow from tobacco use. We know that it has been linked with cancer. We also know that cigarette butts are terrible for our environment, and I will talk a little bit about that later. Really, if we had our time again, would we go down this path? What this bill does is take a staged approach to phasing out cigarettes and tobacco products in our state, and I commend it.

24 September 2024

The Hon. R.A. SIMMS (17:51): I rise to speak in favour of this bill. The Greens believe that our laws need to ensure everybody can live a life where their human rights are respected and where they are safe from harm. We have a long-term commitment to championing the rights of the queer community in this state and we welcome this bill finally coming to this parliament.

This bill to ban conversion practices is the culmination of a long campaign by the LGBTI community. It is a campaign that has been nation wide. New South Wales, Victoria and the ACT have already banned these harmful practices. Queensland has banned them within healthcare environments, Western Australia and Tasmania have committed to reform, and it was a promise of the Malinauskas government that they would tackle this issue if elected. There is no secret about that. It was part of the Labor Party's election platform and they were elected to form government. So, much to the relief of many, they have acted upon that election commitment.

I want to acknowledge the leadership of some of my colleagues in this place over many years on this issue: The Hon. Tammy Franks, who has been a staunch ally and voice for LGBTI South Australians; the Hon. Ian Hunter, who has been a tireless warrior for LGBTI rights and a loud and consistent voice for our community; and the Hon. Michelle Lensink, who has long championed this reform and always supported the LGBTI community in this place. I also acknowledge members in the other place—the Hon. Nat Cook and the Hon. Susan Close—as well as the work of the Attorney-General, Kyam Maher, and his team in preparing this bill for us.

As is so often the case when it comes to LGBTI law reform in South Australia, it has taken cooperation from across the parliament and voices from all sides of politics to get movement on this. It is my hope that members of the Liberal opposition will seize this opportunity to continue our state's proud tradition of achieving LGBTI law reform in a multipartisan way and support this bill. I note the statements made by many on the opposition benches, but I do hope that more members will join the Hon. Michelle Lensink in coming on board and embracing this opportunity.

I also want to acknowledge the survivors of conversion practices, and I thank them for sharing their stories with us. I want to thank the groups that have amplified their voices and advocate for this change: Equality Australia, SARAA, the Sexual Orientation and Gender Identity Change Efforts survivors, and the Brave Network, amongst many others.

As an out and proud gay man, one of only two in this parliament, I do want to take a little bit of time to reflect on the significance of this bill and what it means for the LGBTI community. Fundamental to conversion practices is a belief that there is something shameful about differences in human sexuality and gender identity. Indeed, being part of the LGBTI community is so shameful that you need to repress and alter your own identity.

Despite the far-right conspiracy theories about LGBTI people trying to recruit others to the cause, it is the virtues of heterosexuality that are being promoted actively by conversion practices. It is that world view that is being imposed on LGBTI people.

In moving to ban these practices in this state, this parliament will be sending a clear message to LGBTI South Australians that we do not need to change. That is a vital message for LGBTI people to hear. I know that many LGBTI young people in particular struggle with feelings of fear and shame and that is one of the reasons why conversion practices are so damaging because they feed into those feelings. They reinforce them by forcing young people to deny their true selves and so the consequences of those practices can be lifelong.

I should make it very clear that I never endured conversion practices as a young person, but I do remember how challenging it was grappling with those feelings of shame growing up and so I hate to imagine what it would have been like to have those fears and anxieties being reinforced under the guise of therapy.

I was about 12 when I first realised that I was gay, but for me the bullying started much earlier, well before I actually understood that I was a gay person. I think I would have been about eight or nine when I first started being called a 'poof' and a range of other things I will not repeat on Hansard. Most of the bullying for me centred around the way I walked and the way I talked. It continued on and off throughout my high school years. As a result, I really dreaded what it would be like to try to live a gay life and I certainly never imagined that I would have the opportunities that I have had in my life—the opportunity to stand for parliament, let alone have anybody actually vote for me.

Through the leadership of LGBTI activists who have come before, those opportunities did come for me and for other gay men of my generation. I do salute the work of people like the Hon. Ian Hunter and many others who have been carrying that fight for so many years. Indeed, today I have a happy and a healthy life. When I came out in my early 20s, I was fortunate enough to be supported by friends and family, but I know that everybody is not so lucky and that is why these conversion practices are so dangerous because they prey on young people in particular when they are going through such a challenging, vulnerable period in their lives.

When I gave my first speech in the federal parliament back in 2015, I remarked then that things really do get better and again I do want to use this opportunity to say to any young people who are struggling with their own journeys that this is still the case—things do get better. Stay brave, stay strong and know that things are continuing to change.

This bill is powerful not just because it stamps out conversion practices—and that is a very worthy aim—but because it strikes at the heart of the shame that has been part of the LGBTI experience for far too long.

One of the great things I have observed during my time in politics is the tremendous advances that we have seen in the rights of gay men. Marriage equality is an example of laws that have had a really transformative effect. Indeed, over the last few years since we have seen those amazing changes and the changes that have flowed in community attitude, I have had the courage to do things I never thought I would be able to do here in Adelaide—holding a partner's hand or kissing them on the street without fear of being bashed or verbally abused.

The experiences of younger gay men today are so different to my own experiences and those of other gay men in my generation and that is a truly wonderful thing to observe. It gives me hope that, just as we have seen some really amazing advances in our rights and freedoms, these opportunities will flow through to the rest of the LGBTI community.

Indeed, the big challenge for gay men like myself is to continue the fight for other members of our LGBTI community who need our help. We cannot leave our trans friends behind and today it seems that, like the gay men of the eighties and the nineties and the noughties, trans people are the new targets of right-wing ideologues and the right-wing culture warriors who seek to demonise difference and impose their world views on others. They are now targeting trans kids and I see this bill as being an important way of standing up for those young people.

I will make a few remarks about some of the statements that have been made in the debate. It does strike me as very odd that so many of those who profess to be liberal would seek to impose their morality on others and to exercise control over the personal lives of other people. Surely exercising that kind of control over others or trying to change them is the antithesis of liberalism.

I have also noticed there have been some bizarre falsehoods that have featured during this debate. I will not address all of them, but I think it is often the feature of LGBTI law reform, not only here in South Australia but across the country, that whenever there is an attempt to try to enhance the rights of LGBTI people we are told the sky will fall in. I remember, during the debate about marriage equality, that people suggested that people like the Hon. Mr Hunter and I would seek to marry our pets if marriage equality became part of our law.

I remember when I was on the Adelaide City Council and proposed a rainbow walk for Light Square that we had evidence to the council—a deputation was made from some opponents—that young children would throw themselves down the rainbow walk and into the traffic, and that this project was a safety hazard. These are the sorts of ridiculous claims so often made when we are trying to advance the rights of LGBTI people.

Today, we have heard that this bill will simultaneously do nothing whilst also being a threat to our way of life and undermining the role of the family unit. Opponents of this bill cannot have it both ways; you cannot walk both sides of the street. This bill is worthy of support because it continues to move us in the right direction.

It is important to note this is not just a matter that concerns the LGBTI community and that many other groups have opposed conversion practices. The Australian Medical Association has called for all state and territory governments to impose a ban. In a media release coinciding with the release of a position statement back in 2021, their president, Dr Omar Khorshid, said:

Conversion practices are a blatant example of the discrimination faced by LGBTIA+ people in Australia and have no place in our society.

The AMA noted the fact that conversion practices have no medical basis, and states:

There is strong agreement in the medical profession in Australia that conversion practices have no medical benefit or scientific basis, and that there is evidence of significant harms resulting from such practices.

I note the statement made in her contribution by the Hon. Nicola Centofanti, where she said she had been contacted by a counsellor who said they would not practice should this ban on conversion practices be put in place. I think that is good news, because anybody who would seek to operate as a counsellor and deploy conversion practices should not be working in that field. That is one less troublesome person in that profession.

Some people might believe these arcane practices are a thing of the past. Sadly, these practices do still take place in South Australia. I have heard, as have other members in this place, from survivors who have shared their experiences with us, and I commend them for their bravery in talking about challenging and traumatic events.

Up to one in 10 LGBTI Australians remain vulnerable to conversion practices, with about 4 per cent of all Australians aged 14 to 21 having experienced some form of conversion practice. There is significant harm that comes with these practices, including acute distress, ongoing mental health issues, severe anxiety, depression, symptoms of chronic trauma and PTSD. Some organisations and communities disguise their attempts to suppress someone's sexuality or gender identity as counselling or care. Often these activities are not undertaken by anybody with any formal training in counselling, and they can cause irrevocable harm to people who are convinced or forced to go through such a process.

Sometimes these things are labelled therapy, but therapeutic attempts to alter sexual orientation and gender identity have been discredited by the psychological community for years. In 2015 a report by the Office of the United Nations High Commissioner for Human Rights included conversion therapy in its list of practices that are categorised as torture and ill treatment. Many conversion programs have claimed they only exist to help those who express a desire to change. However, survivors have reported they were coerced by parents or community figures as a result of the ideologies within their religious beliefs.

Many survivors have expressed they were driven by fear of rejection from their family and their community, and therefore they were considered willing, when in fact it was much more complex than that. As I have detailed earlier, so many LGBTI young people confront the circumstances that I faced, where they desperately want to change because they fear what the future might hold. I think it is morally wrong for people to prey on young people in those circumstances.

Any activity that seeks to suppress a person's sexual orientation or gender identity is based on the false premise that queer people are broken and need to be fixed. These practices are steeped in bigotry and discrimination. Rather than recognising and supporting someone in an affirming way, they deny someone the understanding of their true identity.

As stated by my colleague the Hon. Tammy Franks, the Greens firmly believe conversion practices must be banned. We also want to ensure that the government is going to provide services and support to survivors. It is important that we do not just have a legislative approach but that we also provide ongoing support for these people.

My colleague the Hon. Tammy Franks has been engaging with stakeholders and has prepared a series of amendments to improve the bill. She has outlined the basis of these within her second reading speech. Additionally, I will move one amendment, should the Hon. Tammy Franks' amendment not be successful, which will extend the reporting period to six years, and I will speak a little bit more about that in the committee stage.

I do understand that some members of the LGBTI community will look at this bill and say that it does not go far enough. I understand that. The Greens hear you and that is why we are advancing these amendments, but if these amendments fail we will of course be voting in favour of this bill. While the bill is not perfect, it represents another important milestone in the journey for LGBTI rights in our state, and of course the fight continues. Those who seek to change LGBTI people or to bully us into denying our identities must know this: we are here, we are queer, we are going to keep up the fight; out of the closet, into the streets and into the parliament.

24 September 2024

The Hon. R.A. SIMMS (15:08): I seek leave to make a brief explanation before addressing a question without notice to the Minister for Industrial Relations and Public Sector on the topic of health workers.

Leave granted.

The Hon. R.A. SIMMS: Today, it has been reported that in Victoria an agreement has been reached between the government and the union to increase paramedic wages. It comes after negotiations have been ongoing since February 2023 and resulted in industrial action in March. Under the four-year agreement, paramedics will now receive wage increases ranging from just under 17 per cent to 33 per cent over four years. Victorian Ambulance Union secretary, Danny Hill, has said that senior paramedics will soon become some of the most well compensated in the country.

My question to the Minister for Industrial Relations and Public Sector is: what is the government doing to ensure that South Australia can compete for qualified health workers with other states that are willing to pay much higher wages than here in South Australia, and will the government commit to matching the pay increases we have seen in other jurisdictions to stop paramedics from leaving South Australia and potentially compounding the ramping crisis that Labor promised to fix?

The Hon. K.J. MAHER (Minister for Aboriginal Affairs, Attorney-General, Minister for Industrial Relations and Public Sector) (15:09): I thank the honourable member for his question and his interest in these areas and his slightly, as always, provocative questions. If his question is will I make a commitment here in question time to match the very highest offer that occurs anywhere around Australia for every aspect of an enterprise bargaining agreement, no I won't. What I will commit to is what we said before the election and we have continued to do: enter each round of bargaining for an industrial agreement in good faith with their representatives in a particular union.

The honourable member mentioned paramedics. I haven't seen the details of exactly what was negotiated, what reforms went with pay increases which might be efficiency reforms within the EB and what parts of the workforce and paramedics different pay rises might apply to, but what I will say is that genuine desire to bargain in good faith was on display very soon after we came to government. Members will recall that for the four long years of a Liberal government under the former minister, the Hon. Rob Lucas, who would stand up and very proudly demonise union leaders, there was not a pay rise in the whole four years for ambulance workers in South Australia.

I am very proud that as a new Labor government we were able to come to an agreement with the union that represents ambulance workers, voted on by the members of that union, not just for a pay rise for the years going forward over the three years of that industrial agreement but for back pay in each year that they missed.

Members interjecting:

The Hon. K.J. MAHER: For the back pay in each year that they missed. So we will continue to negotiate in good faith with each industrial agreement that comes up for discussion.

The Hon. R.A. SIMMS (15:11): Supplementary: given the minister has ruled out matching the pay offer made in Victoria, is he concerned that South Australia is at risk of losing health workers to other states?

The Hon. K.J. MAHER (Minister for Aboriginal Affairs, Attorney-General, Minister for Industrial Relations and Public Sector) (15:11): I will reiterate again what I think I answered—what the honourable member's question is: will I here and now agree to the highest settlement that occurs in every area in the health system in EBs right around the country? No, I won't do that, but it's not just pay that makes South Australia a particularly attractive place to live. I think the honourable member will agree that this city and this state have many natural benefits, over and above many other cities and states around Australia, that contribute to so many people wanting to call Adelaide home.

27 June 2024

The Hon. R.A. SIMMS (14:54): I seek leave to make a brief explanation before addressing a question without notice to the Minister for Industrial Relations and Public Sector on the topic of a pay rise for nurses.

Leave granted.

The Hon. R.A. SIMMS: Yesterday, the Victorian government and the Australian Nursing and Midwifery Federation agreed to a 28.4 per cent pay rise for nurses and midwives over the next four years. The agreement includes allowances for a change of ward and being on call. There is also a right-to-disconnect clause and a change to night shift penalties. The Victorian Premier, Jacinta Allan, told The Age, and I quote:

This is absolutely backing in our nurses and midwives. They are the backbone of our health and hospitals system.

My question, therefore, to the Minister for Industrial Relations and Public Sector is:

1. Will the Malinauskas government match the Victorian pay rise for South Australian nurses and midwives, and if not, why not?

2. What is the government doing to ensure that our nurses don't simply pack up and move over to Victoria?

The Hon. K.J. MAHER (Minister for Aboriginal Affairs, Attorney-General, Minister for Industrial Relations and Public Sector) (14:55): I thank the honourable member for his question. In relation to whether we will immediately institute the results of an interstate jurisdiction's enterprise bargaining into industrial instruments in South Australia after having gone through a bargaining process, the short answer to that is, no, we won't—and I am not sure the honourable member would have expected much different from an answer in relation to that.

What we will do, though, as I have said in this chamber a number of times before, is bargain in good faith with public sector unions, which represent employees in a whole range of areas, including the Australian Nursing and Midwifery Federation, which represents nurses in South Australia and around the country. I don't have the date in front of me, but I think it was sometime in mid to late 2022 when the last industrial agreement was negotiated and signed with the union representing nurses in South Australia. Sometime in the next couple of years that will be up for renegotiation.

What I will say and can commit to is: unlike the last government, we don't come to the table in bad faith with preconceived notions about what is or isn't on the table. We will come to the negotiating table in good faith and are happy to negotiate terms and conditions that are fair for nurses, also recognising the needs of South Australia.

The Hon. R.A. SIMMS (14:56): Supplementary: given the government won't commit to matching Victoria's offer, is the minister concerned that these nurses and midwives are going to leave South Australia and move interstate, where they can get a better offer?

The Hon. K.J. MAHER (Minister for Aboriginal Affairs, Attorney-General, Minister for Industrial Relations and Public Sector) (14:57): I thank the honourable member for his question. I do not have a jurisdictional comparison of the base that this has been taken from, and pay rates and the exact matching of various conditions—and that is one element of where someone decides to work. A very important element is the quality of life you get while you are working as well. I might be accused of being biased, but I think that living in South Australia, and Adelaide in particular, affords you a quality of life that you can't find in many other places in this country.

The Hon. R.A. SIMMS (14:57): Supplementary: in light of the government's failure to match the offer in Victoria and the significant crisis that is gripping our health system—

The PRESIDENT: The Hon. Mr Simms, did you start with—I missed the first words. If you haven't started with a question, you can't have a preamble.

The Hon. R.A. SIMMS: Is it not the case, given the crisis that is befalling our health system and the fact that the government is not going to actually match the offer that has been put on the table over in Victoria, that people are going to simply move interstate and cause further problems in our health system?

The Hon. B.R. Hood: I will allow it.

The PRESIDENT: The Hon. Ben Hood will allow it. If that is the case, then we had better allow it.

The Hon. K.J. MAHER (Minister for Aboriginal Affairs, Attorney-General, Minister for Industrial Relations and Public Sector) (14:58): I thank the Hon. Ben Hood for allowing it. I think the honourable member is taking some liberties. He well knows that is not how the industrial relations system works. It doesn't happen, when there is one agreement in one jurisdiction somewhere, that it automatically becomes something that every jurisdiction then gets too.

I was going to suggest that if there were a parliament somewhere else around the world that paid more than here would the honourable immediately move to that parliament because it has better wages? Then I remembered that the honourable member has been in almost every form of government—every single form of government, including local government, that we have in this country—so maybe he is working his way up in that respect.

I think what that does indicate is that it is certainly a factor but there are a lot of other factors that determine where someone chooses to live, where someone chooses to raise their family, and I think South Australia has a lot of advantages in that respect.

15 May 2024

The Hon. R.A. SIMMS (17:06): I move:

That this council—

1. Notes that:

(a) of the 17.75 billion cigarettes estimated to be consumed in Australia each year, between 30 per cent to 75 per cent end up as litter;

(b) cigarette waste makes up to 14 per cent of total waste items found during Clean Up Australia Day;

(c) 34 per cent of total litter counted by KESAB is cigarette waste; and

(d) at the Conference of Parties (COP10) in February 2024, the World Health Organization Framework Convention on Tobacco Control has resolved to urge signatories to take action on the environmental impact of cigarette waste.

2. Acknowledges that littered cigarette butts:

(a) contain cellulose acetate and can take 15 years to break down in sea water;

(b) create plastic microfibres as they degrade; and

(c) contain over 7,000 chemicals and one butt can contaminate 40 litres of water.

3. Recognises that:

(a) Spain has introduced regulations to require tobacco companies to pay for the clean-up of cigarettes;

(b) San Francisco collects litter tax from retailers and charges tobacco companies for the cost of cleaning up; and

(c) the NSW Environment Protection Authority has initiated consultation on cigarette butts through introducing design standards to design out plastic tobacco filters.

4. Calls on the Malinauskas government to:

(a) take any possible action to ensure the tobacco industry is kept accountable for the waste they produce; and

(b) raise the matter with the national environment ministers at their next meeting.

This motion notes the huge amount of cigarette waste that is consumed in Australia each year. It notes the number of cigarettes that are consumed. People are not necessarily consuming the cigarette waste, although cigarettes are adverse to their health. This motion notes that of the 17.75 billion cigarettes estimated to be consumed in Australia each year, between 30 to 75 per cent of those end up as litter. Indeed, cigarette waste makes up 14 per cent of total waste items found during Clean Up Australia Day, and 34 per cent of total litter that is counted by KESAB is cigarette waste.

There have been efforts around the world to make cigarette companies responsible for the waste that they produce. Indeed, early last year I introduced a bill that would have set up a mechanism whereby these cigarette companies could be taken to task for the waste that they produce. In Spain, they have introduced regulations to require tobacco companies to do that. San Francisco now collects litter waste from retailers and charges tobacco companies for the cost associated with cleaning up, and the New South Wales Environment Protection Authority has initiated consultation on cigarette butts through introducing design standards to design out plastic tobacco filters.

This is calling on the Malinauskas government to take any action possible to ensure the tobacco industry is kept accountable for the waste they produce and, critically, to raise the matter with the national environment ministers at their next meeting to see if there can be a national coordinated approach to this issue.

Cigarette butt waste is terrible for our environment. Some interesting statistics for you: cigarette butts contain over 7,000 toxic chemicals, including arsenic, lead and nicotine. When these butts are littered, they leach these harmful substances into our waterways and soils. It is estimated that each cigarette butt can contaminate up to 40 litres of water. Water in South Australia, as we all know too well, is a precious resource, and it is not acceptable for that level of pollution to be in what little we have.

Beyond the leaching of chemicals, cigarette butts are also slow to degrade in the environment, and they release microplastics; that is, tiny plastic fibres that are almost impossible to remove once they are dispersed. These microplastics are ingested by our marine life, they work their way up the food chain, and they expose humans also to these harmful effects.

Cigarettes are not just terrible for community health. I know the Hon. Frank Pangallo is passionate about that issue and is raising that with some law reform ideas, and I am certainly very interested to learn more about that. As well as cracking down on the impact of cigarettes on community health, we also need to look at what we can do to make these big companies responsible for the terrible effect they have on the environment.

Just two years ago, The Guardian reported that microplastics had been found in human blood for the first time, with almost 80 per cent of people tested showing that microplastics were present. I find that startling. There are concerns that microplastics can lodge in human organs and other body systems, and we do not yet fully understand the health implications of that.

The environmental impact of cigarette waste is a problem that is only getting worse. However, as I indicated in my introductory remarks, some jurisdictions around the world are taking action. In Spain, regulations have now been developed that require cigarette companies to pay for the clean-up of the litter, and in San Francisco retailers are charging what is known as a litter tax, with the proceeds going towards the cost of collecting and disposing of cigarette waste. Here in Australia action is being taken on this in New South Wales.

We in the Greens would like to see the Malinauskas government follow the lead of these other jurisdictions and take action on this to ensure that we hold the feet of these big tobacco companies to the fire to ensure they take responsibility for the waste they produce.

15 May 2024

The Hon. R.A. SIMMS (16:56): I move:

That this council—

1. Notes with concern that the number of hours patients spent ramped in ambulances, awaiting transfer to hospital emergency departments, has risen from 328 per month in July 2017 to 4,095 per month in March 2024.
2. Notes with concern that South Australians are struggling to access a GP, with only 11 per cent of GP clinics offering bulk-billing in regular business hours.
3. Calls on the Malinauskas government to tackle the ramping crisis by:

(a) fully subsidising 200 new free GPs for people with a health care card;

(b) establishing special 'transit wards' at major Adelaide hospitals to expedite ambulance patient transfers;

(c) establishing a statewide bed manager to oversee all patient transfers and ensure prearranged bed availability for admitted patients and avoiding ramping of interhospital transfers going to an ED; and

(d) establishing rapid off-load procedures for transferring patient care within 30 minutes of arrival at emergency departments.

This motion notes with concern the number of hours that patients are spending ramping in ambulances waiting for transfer to hospital emergency departments. It also notes the concerns of South Australians in terms of being able to access a GP—at the moment in our state only 11 per cent of GP clinics offer bulk-billing in regular business hours—and it calls on the Malinauskas government to tackle the ramping crisis by implementing the recommendations of the Ambulance Employees Association but also fully subsidising 200 new free GPs for people who have a health care card.

The ramping crisis continues in our state. We have heard both sides of politics battle it out for years now. What people want are solutions that can actually be implemented. We know, of course, that the Malinauskas government, as part of their election pledge, made a commitment to fix the ramping crisis. We know that there are no easy solutions, but I would have thought the best starting point is to listen to the recommendations of the Ambulance Employees Association.

The number of hours patients have spent ramped in ambulances awaiting transfer to our hospital emergency departments has risen from 328 hours per month in 2017 to a colossal 4,095 hours per month in March. That is a slight decrease from the record high of 4,285 lost hours in November of last year, so it is nothing to celebrate. It is out of control.

What this tells us is that there are system wide issues that go beyond politics and who is in charge, because the reality is that neither Labor nor the Liberal Party have been able to get this under control. The crisis has reached a critical tipping point, and we need to look at all options. We need to look at what we can do to improve our healthcare system—that is, reduce the need for people to seek emergency support but also to improve the processes that are undertaken when dealing with emergency situations.

The ramping crisis in South Australia is compounded by the reality that people in our state are continuing to struggle to access even the most basic primary care services. According to the Cleanbill 2024 Blue Report, only 11 per cent of South Australian GP clinics are bulk-billing for standard consultations during regular weekly business hours. The same report shows that the average out-of-pocket cost has increased by 7.2 per cent in South Australia over the last 12 months. I am concerned that that is going to increase further as a result of the end of the amnesty period for payroll tax and that is why the Greens were pleased to work with the Hon. Connie Bonaros to pass a motion calling on the government to remedy that.

This could be addressed also by subsidising 200 new GP positions specifically designated for people who have a health care card. This investment will ensure equal access to quality primary care and will provide the first line of defence against further strain on our emergency departments.

No South Australian should be forced to forgo seeing a doctor due to their financial circumstances. It is a right of every citizen in our community to be able to access the health care that they need. In the middle of a cost-of-living crisis, we need to ensure people can access the fundamental human right of affordable health care. This is not the United States where people are priced out of going to see a doctor. It is not how we do things here in Australia. It is not how we do things here in South Australia.

In April last year, the Ambulance Employees' Association issued a media release that outlined some key solutions to the ramping crisis. These are not new ideas. The AEA has stated that these proposals were sent to all political parties ahead of the 2022 election. Two years on, we still have not seen these recommendations being implemented.

The first suggestion is to establish transit wards at our major hospitals across the Adelaide metropolitan area. These dedicated wards would serve the crucial function of expediting the transfer of patients who need to be moved from an ambulance or discharged. According to the AEA, currently in most metropolitan hospitals in Adelaide when a patient is ready to be discharged and requires ambulance transport, e.g. to a RACF or to a disability facility, they remain in their ward awaiting a transfer ambulance to arrive. As this is not an urgent ambulance attendance, these transfers can be significantly delayed for many hours. During this time, the bed is unable to be utilised by a patient awaiting admission from the ED.

Further delays occur when an ambulance arrives and the patient is not ready to be discharged, despite being booked in by the hospital in advance. Delays of medication dispensation by pharmacy or discharge paperwork yet to be completed could all contribute to delays in the patient's discharge, leading to the ward bed remaining occupied and not being able to receive the next patient. That is the advice of the AEA. It is not me saying it. These are the experts who work in this field. Transit wards could alleviate the current strain on beds, ambulances and emergency departments by ensuring that there is a more efficient system in place.

Secondly, a statewide bed manager could be established to oversee all patient transfers and guarantee that hospital beds are available and ready at the time of transfer. A centralised and coordinated approach is required to address the occurrence where transfers arrive at hospitals without a bed being available on the ward. A statewide bed manager could coordinate the available beds to ensure that people can be transferred directly to the relevant ward or unit rather than clogging up emergency departments and potentially duplicating diagnostics.

Lastly, we need to implement rapid off-load procedures to transfer patient care from ambulance to hospital staff within a maximum of 30 minutes of arrival at the emergency department. The Australasian College for Emergency Medicine position statement on ambulance ramping has stated that:

Within 30 minutes of arriving at an ED, 100 per cent of patients should have their handover completed.

The AEA have stated that:

Current policies and procedures within SA Health are demonstrably inadequate at mitigating this practice.

They advocate that rapid off-load procedures could free up ambulance availability and would also improve patient safety.

We have clear guidance from people on the frontline of this crisis. These are reforms that are proposed by the AEA. They are supported by the Greens. They are the ones who are witnessing the impacts of this ramping crisis firsthand. They know the solutions. This really calls on the Malinauskas government to listen to the experts and to take the steps necessary to get this crisis under control.

I know people will ask, 'How could the government fund this?' Well, budgets—and we will have a state budget handed down very soon—are about priorities. This Labor government gives over $100 million of subsidies to the fossil fuel industry, an industry which we know promotes adverse health outcomes for our community. They could cut those subsidies and put that money into our health system. Indeed, the Greens have done the math, and we have worked out that cutting those subsidies would be more than enough to fund what is being advocated for by the AEA, as well as hiring these 200 GPs to provide support for South Australians who are doing it tough.

The Malinauskas government has been in power for two years now. They need to step up and get this health crisis under control, and listen to the experts in this field. I will say, it is not just the fault of the Malinauskas government, albeit the Labor Party has been in power for 18 of the last 30 years in this state. They must shoulder a lion's share of the blame, but neither side of politics has been able to get this crisis under control. I think the community is sick of the bickering, and they actually want to see some real solutions here.

15 May 2024

The Hon. R.A. SIMMS (15:04): I seek leave to make a brief explanation before addressing a question without notice to the minister representing the Minister for Health on the topic of junk food advertising.

Leave granted.

The Hon. R.A. SIMMS: In a study by the Cancer Council, it was revealed that of the 253 advertisements related to food or drink on public transport assets within 500 metres of schools, almost 80 per cent were promoting junk food. Last year, I introduced a bill to restrict junk food advertising on public assets, public transport and within 500 metres of schools.

In February, a study published in the British Medical Journal found that high exposure to ultra processed food is associated with an increased risk of 32 health outcomes, including cancer. While the government opposed the bill, they did indicate, back on 14 September last year, that they would establish a working group to consider banning junk food advertising on public transport infrastructure. My question to the minister representing the Minister for Health therefore is: what is the status of that working group, when has it convened, and what action is the government taking on this issue?

The Hon. K.J. MAHER (Minister for Aboriginal Affairs, Attorney-General, Minister for Industrial Relations and Public Sector) (15:05): I thank the honourable member for his question and I will be sure to pass that on to the minister in another place and bring back a reply for him.

20 March 2024

The Hon. R.A. SIMMS (16:40): I move:

That this council—

1. Acknowledges that:

(a) the Royal Australian College of General Practitioners South Australia (RACGP SA) has launched a campaign for the state government to stop applying payroll tax to general practitioners; and

(b) South Australia is in the middle of a cost-of-living crisis and many people are already struggling to cover the costs of essentials like medical appointments.

2. Notes that:

(a) the patient engagement platform HotDoc has released figures that show that 95 per cent of clinics are planning to increase patient fees by an average of $12 per appointment in response to the payroll tax and only 28 per cent of patients would continue to see their regular GP (albeit less regularly), if fees increased; and

(b) the Queensland government has provided a payroll tax ruling clarifying that patients' fees paid directly to a GP for their services would not be subject to payroll tax.

3. Calls on the Malinauskas government to align with the Queensland government's approach to rule out payroll tax on patients' fees paid directly to GPs for their services.

This is a really important issue for this parliament to deal with. I note that the Hon. Connie Bonaros advanced a motion on a similar topic and I certainly share the concerns that she has expressed, but this motion from the Greens goes a little bit further than that because we are not just calling for an amnesty, we are calling for the Labor government to go a step further and that is actually rule out applying this payroll tax to GP services.

Queensland has done that. They have actually provided a payroll tax ruling that clarifies that patients' fees that are paid directly to a GP for their services would not be subject to a payroll tax. Well, the patients and medical practitioners of our state do not simply need an amnesty—in effect, a stay of execution—what they need is certainty going forward and for this money grab to be ruled out.

I understand that the state Labor government are in a difficult financial position. I understand that and that is through no fault of the government. We know of course the significant costs that have been associated with managing COVID, not just here in our own state but right across the country. But budgets are about choices and this government does not have to go down the path of slugging medical practitioners, and slugging, by extension, patients with increased fees. There are lots of other alternatives.

The Greens have referenced previously work of the Australia Institute, which finds that there was about $150 million that is going to fossil fuel companies in subsidies, direct money from the state government. That money could be put into our health system to deal with the crisis that we are facing. That would be an appropriate course of action, rather than a money grab that is going to cause vulnerable South Australians to be paying more to go to see a doctor. That is not something we want to see.

The Greens certainly support the campaign of the Royal Australian College of General Practitioners for the government to stop applying payroll tax to the work of general practitioners, indeed all healthcare professionals. We are concerned that going to the dentist could also become more expensive in South Australia should this medical tax get the green light from the Malinauskas government.

I want to reference some of the work of the Royal Australian College of General Practitioners (RACGP). They claim that the payroll tax for GPs would result in higher fees for patients, reductions in bulk billing or more GPs leaving the workforce. That, of course, would not be a good outcome for patients or the medical profession in general. We look at that with the backdrop of the ramping crisis that is getting worse and worse in this state.

Some might say, 'Do not trust politicians when they talk about dealing with these matters.' I will not repeat the phrase, but some say, 'That is all BS'. The reality is that people do rely on parliaments to deal with these sorts of matters. People do rely on governments to solve these sorts of matters and they do not expect budget black holes to be plugged by the sick in our community.

Out-of-pocket costs for medical services are rising and South Australians are unable to afford basic health care and the Greens believe, of course, that everybody is entitled to that. Last year, a Productivity Commission report showed that there was a 50 per cent increase in Australians who delayed or avoided seeing their doctor because they could not afford it. That was up by 2.4 per cent of people to 3.5 per cent. At the same time, GPs are increasingly being forced to stop bulk billing to ensure they can afford to stay afloat.

That same report also revealed there are approximately three million avoidable presentations to public hospital emergency departments that could have been handled by a GP. The reality is that if we do not fund GPs appropriately, if we do not invest in preventative care, you are going to see more people presenting in emergency and we know that our hospital system is already struggling to cope.

As we face both a cost-of-living crisis and an emergency health system at full capacity, we need to be looking at what we can do to relieve the pressure, not just compound it. In June last year, the Treasurer issued an amnesty on payroll tax to tenant GPs to 30 June of this year. This came after the Supreme Court of New South Wales Court of Appeal found that tenant GPs who pay a percentage of their earnings to a clinic rather than being paid a wage count as employees for payroll tax purposes.

The decision by the New South Wales court caught practices by surprise and according to the RACGP gave them no choice but to raise patient fees. The state government amnesty was welcomed by the RACGP to give them time to work through the implications for tenant GPs.

It is my understanding that it is not just general practitioners who fall into this category. Yesterday, a dentist contacted my office and reported that dental and psychology practices are also potentially impacted by this ruling, so the Greens call on the government to rule out applying this new tax not just to GPs but also to medical practitioners. It is important that we consider the impact that this could have on our health system in the middle of this health crisis.

Data from HotDoc reveals that 95 per cent of clinics are planning to increase patient fees by 12 per cent in response to this payroll tax. That is a terrible outcome for patients who are already feeling the pinch. Research from The Pharmacy Guild of Australia has shown that 48 per cent of patients would move to a different GP if they stopped bulk billing. Any sensible person would look at this and realise that this will end up with bulk billing facilities being overrun and being more burdened than they are at present. It will also result in patients either delaying their health care or forking out money they cannot afford to pay for the services they need.

On 21 February this year, the Queensland government issued its own ruling that patient fees paid directly to a GP for their services will not be subject to a payroll tax. The Queensland ruling applies to medical centres where medical practitioners are conducting business or providing medical services and I note that this would capture dentistry, psychology and other medical services in addition to GPs.

This motion aims to put into action the calls from the RACGP for the Malinauskas government to match Queensland to exempt medical practitioners from payroll tax both to support healthcare professionals and to also ensure patients are not being slogged for extra fees in the middle of this cost-of-living crisis.

This is a government that was elected on a platform of fixing our health system. Well, you cannot fix our health system if you price South Australians out of getting in to see a GP. You cannot fix our health system and you cannot get ramping under control if you make it more difficult to get in to see a doctor, dentist or psychologist.

All of these things are fundamental to our health system, and we cannot see South Australians being priced out of getting the care that they need. So I really urge the Malinauskas government not just to extend the amnesty but to actually rule it out, knock the nail on the head and bring this matter to a close so that there is certainty for our medical professionals and certainty for vulnerable people in our community: the sick who need the support of those professionals.

14 November 2023

The Hon. R.A. SIMMS (15:10): I seek leave to make a brief explanation before asking a question of the Minister for Regional Development on the topic of LGBTIQ equality in the regions.

Leave granted.

The Hon. R.A. SIMMS: In 2016 and 2017, the government of Victoria began a roadshow in rural and regional areas in their state as part of their LGBTIQ Equality Rural and Regional Program. The program is focused on, and I quote from the government of Victoria website:

…improving mental health outcomes, boosting population retention and economic inclusion, building capacity for communities to empower themselves, developing lasting networks between LGBTI communities, services providers and government agencies and improving broader community support for inclusion and identity.

The government of Victoria advises that the:

…roadshow visited more than 29 towns…engaging with local LGBTIQ+ communities, allies, business leaders, representatives of local service providers and local government.

An evaluation of the program found it had a positive impact on LGBTI people in regional Victoria with, and I quote from the website, 'LGBTI people reporting greater acceptance and displays of support in their communities.'

The government of Victoria is now developing a Rainbow Ready road map to respond to the needs of LGBTI people in the regions who were identified during the roadshow. My question to the minister therefore is: does she have plans to hold a similar roadshow to engage with LGBTI people in regional South Australia and, if not why not?

The Hon. C.M. SCRIVEN (Minister for Primary Industries and Regional Development, Minister for Forest Industries) (15:12): I thank the honourable member for his question. I am not aware of any government proposals to have such a roadshow. Certainly, as a government we have done a wide range of measures in terms of increasing the opportunities for communication and collaboration with various groups within the community. I am happy to check with the Minister for Human Services in the other place to see if there are any such plans.

The Hon. R.A. SIMMS (15:12): Supplementary: will the minister consider the idea of a roadshow herself and, in particular, will she consider developing an LGBTIQ equality rural and regional program like her Victorian counterparts?

The Hon. C.M. SCRIVEN (Minister for Primary Industries and Regional Development, Minister for Forest Industries) (15:13): Such a roadshow or policy or strategy would fall within the remit of the Minister for Human Services in the other place. She has certainly been very open to giving particular consideration to the needs of the community who are located in regional areas, for which I commend her. I will ask whether she has considered such a proposal to which the honourable member refers.

23 January 2024

In reply to the Hon. R.A. SIMMS (14 November 2023).

The Hon. C.M. SCRIVEN (Minister for Primary Industries and Regional Development, Minister for Forest Industries): The Minister for Human Services has advised:

The Equality Project, a national LGBTIQA+ organisation, is currently conducting interviews with LGBTIQA+ South Australians with a goal of understanding people's experiences, connections to community, and identifying possible changes to better support LGBTIQA+ people. This project, which is funded by the Fay Fuller Foundation, has a particular focus on engaging with LGBTIQA+ people in regional South Australia.

The LGBTIQA+ Minister's Advisory Council recently had an update on the findings from the peer-to-peer interviews conducted to date as part of this initiative, including the unique needs emerging from LGBTIQA+ people living in regional and rural South Australia.

The findings of this project will be used to inform a potential roadshow like the ones that have occurred in Victoria and future actions the government can take to better support LGBTIQA+ people in regional South Australia.

1 November 2023

The Hon. R.A. SIMMS (19:46): I rise to speak on the report of the Social Development Committee on its inquiry into the impact of the National Disability Insurance Scheme (NDIS) on South Australians living with disability who have complex needs and are, or are at risk of, residing for long periods in inappropriate accommodation.

I mean no disrespect to the committee or members of the community who have a significant interest in this proposal when I indicate that my remarks will be very brief, simply in recognition of the lateness of the hour. It was a privilege to participate in the inquiry as a member of the Social Development Committee, along with the Hon. Ian Hunter, who is the Chair of the committee and obviously a member of this place.

The committee looked into a range of important matters. Its terms of reference included the ability to access and navigate the requirements of the NDIS; the timeliness of approval for appropriate specialist disability supports, including home and living decisions through the NDIS and the processes that may lead to delays; the adequacy of funding in the NDIS plans to fund the supports required; the ability of the NDIS workforce and market, including the specialist disability accommodation policy settings and the market in South Australia and the role that it plays in delivering necessary accommodation and funded supports; the impact on the wellbeing of participants of these inappropriate accommodation arrangements; any negative impacts on state government services; and any other related matters.

The committee has made a number of recommendations, and the Hon. Ian Hunter spoke to those in his remarks during the last parliamentary sitting. I take this opportunity to thank all members of the committee but also the secretariat for their work in pulling together the evidence, which was substantial, and crafting the recommendations, and all the people who took the time to appear before the committee and share their stories with us. Some of their stories were quite personal and at times it was an emotionally challenging committee to be on and to hear that evidence, but I know that all of us really appreciated hearing from people impacted by this area and hearing about their lived experiences.

It is my hope that the government will take action in relation to the recommendations. They are detailed. There is some really good work here that could be done by the government that I think would offer some real improvements for impacted South Australians. With that, I conclude my remarks.